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The following is a summary of “Trends in Infective Endocarditis Mortality in the United States: 1999 to 2020: A Cause for Alarm,” published in the December 2023 issue of Cardiology by Chobufo et al.

Limited data exist on national trends in mortality caused by infective endocarditis (IE) in the United States. To address this gap, this study utilized the Centers for Disease Control and Prevention’s Wide‐Ranging Online Data for Epidemiologic Research database spanning from 1999 to 2020. Using the International Classification of Diseases, Tenth Revision, Clinical Modification codes, IE and substance use were identified as primary factors contributing to mortality. The findings revealed a decline in age-adjusted mortality rates associated with IE between 1999 and 2020. 

However, a concerning trend emerged, indicating a significant acceleration in crude mortality rates among individuals aged 25–34 years (average annual percentage change, 5.4 [95% CI, 3.1–7.7]; P<0.001) and 35–44 years (average annual percentage change, 2.3 [95% CI, 1.3–3.3]; P<0.001). Conversely, mortality rates remained stagnant in the 45–54 years age group (average annual percentage change, 0.5 [95% CI, −1.9 to 3]; P=0.684) and displayed a significant decline in those aged ≥55 years. Notably, there was a drastic increase in concomitant substance use disorders among individuals aged 25–44 years, with IE as a contributing factor to mortality (P<0.001). Geographically, states such as Kentucky, Tennessee, and West Virginia exhibited an acceleration in age-adjusted mortality rates due to IE, while other states predominantly experienced a decline or static trend.

In conclusion, the overall population saw a decline in age-adjusted mortality rates related to IE. However, the alarming acceleration in mortality rates within the 25‐ to 44‐year age group raises significant concerns. Notably, regional disparities were observed, particularly in Kentucky, Tennessee, and West Virginia, where mortality rates due to IE increased. Speculatively, this acceleration is believed to be primarily linked to the opioid crisis, which has significantly impacted several states, especially involving younger adults. The findings underscore the need for targeted interventions and public health measures to address these concerning trends and mitigate the impact of IE-related mortality, particularly among younger age groups affected by substance use disorders.

Source: ahajournals.org/doi/10.1161/JAHA.123.031589